Life with and beyond breast cancer among women in Nigeria

Breast cancer survivors across Africa face significant socioeconomic challenges, compounded by limited formal support systems and scarce survivorship data from low-and middle-income countries. In Nigeria, understanding the availability and role of existing support structures, as well as survivors lived experiences and care needs, is essential for informing service development. Qualitative evidence capturing these experiences is scarce. This thesis addresses this gap by exploring the experiences of women living with and beyond breast cancer in Nigeria. Study 1 was a focus group discussion presenting the narrative accounts of breast cancer survivors from diagnosis and exploring their culture and beliefs to living with cancer. Participants highlighted delays in diagnosis and treatment, often driven by financial constraints, family and community influences, stigma, and fear. Study 2 was a systematic review (n=48) that synthesised evidence relating to the experience of breast cancer survivorship across sub-Saharan Africa. It identified key gaps in the literature, particularly around benefit-finding, identity reconstruction, and broader concepts of wellbeing in African contexts. Study 3 involved in-depth interviews exploring the lived experiences of women (n= 28) living with and beyond breast cancer. Participants reported major disruptions following diagnosis, including emotional distress, changing roles and relationships, and financial strain. Study 4 was a second in-depth interview which explored healthcare professionals’ (n=19) experiences of delivering breast cancer care in Nigeria. Findings showed that post-treatment care was largely focused on biomedical surveillance, with limited emphasis on holistic and longer-term supportive care. This PhD draws together findings across Studies 1 to 4 to present practical opportunities to strengthen survivorship care through context-appropriate models that improve continuity, incorporate psychosocial support and enhance information and communication. Together, these insights provide a platform to inform advocacy and support policy and service improvements in breast cancer care in Nigeria to enhance survivors’ quality of life.